Individual
DR. SANDRA MARCHESE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5921 RILEY PARK DR, FORT SMITH, AR 72916-6103
(479) 420-1221
(479) 646-0133
Mailing address
5921 RILEY PARK DR, FORT SMITH, AR 72916-6103
(479) 420-1221
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
E-1554
AR
207ND0101X
MOHS-Micrographic Surgery Physician
E1554
AR
207ND0900X
Dermatopathology Physician
E-1554
AR
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
E-1554
AR
207NP0225X
Pediatric Dermatology Physician
E1554
AR
207NS0135X
Procedural Dermatology Physician
E-1554
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139972001
—
AR
Enumeration date
06/27/2005
Last updated
08/30/2023
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